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BODY OF KNOWLEDGE FOR

Medical Practice
Management
2nd edition

About MGMA
Medical Group Management Association (MGMA) is the premier membership association for professional administrators
and leaders of medical group practices. Since 1926, MGMA has delivered networking, professional education and
resources, and political advocacy for medical practice management. Today, MGMAs 22,500 members lead 13,600
organizations nationwide in which some 280,000 physicians provide more than 40 percent of the healthcare services
delivered in the United States.
MGMAs mission is to continually improve the performance of medical group practice professionals and the organizations
they represent. MGMA promotes the group practice model as the optimal framework for healthcare delivery, assisting
group practices in providing efficient, safe, patient-focused and affordable care. The American College of Medical Practice
Executives (ACMPE) is the standard-setting and certification body of the Medical
Group Management Association (MGMA), and promotes the professional growth
of leaders. By developing the Body of Knowledge for Medical Practice Management,
ACMPE provides a central framework for MGMA resources. MGMA is headquartered
in Englewood, Colo., and maintains a government affairs office in Washington, D.C.
Please visit mgma.com

BODY OF KNOWLEDGE FOR

Medical Practice
Management
2nd edition

Whats inside
1. About the Body of Knowledge . ................................................................................................. 2
2. Professional Development: Four Competencies . ................................................................ 4
3. Business Operations .................................................................................................................... 6
4. Financial Management .............................................................................................................. 8
5. Human Resource Management ............................................................................................. 10
6. Information Management ...................................................................................................... 12
7. Organizational Governance . .................................................................................................. 14
8. Patient Care Systems ................................................................................................................. 16
9. Quality Management . .............................................................................................................. 18
10. Risk Management ...................................................................................................................... 20
11. Appendix: ACMPE Board Certification and Fellowship . ............................................... 22
12. Credits .............................................................................................................................................24

We encourage you to share it:


> Educate others about the profession by sharing the Body of Knowledge with colleagues, staff,

physicians, faculty, students and business associates. For additional free copies of this brochure (Item
5961), visit mgma.com/bok or call toll-free at 877.275.6462, ext. 1888.
> T he Body of Knowledge for Medical Practice Management was created by ACMPE and contains

copyrighted material. Anyone is welcome to use it, reprint it, reference it and share it. Permission to
reproduce excerpts is granted as long as attribution of ACMPEs authorship is displayed as follows:
The Body of Knowledge for Medical Practice Management was developed by the American
College of Medical Practice Executives (ACMPE), the standard-setting and certification body
of the Medical Group Management Association (MGMA).

2011, American College of Medical Practice Executives (ACMPE). All rights reserved. Unauthorized use prohibited.
Permission to reproduce excerpts is granted so long as specific attribution of ACMPEs authorship is displayed.

What does it take to be a successful medical practice management executive?


You are in one of the fastest growing and most rewarding careers in healthcare management.
The role of a medical practice executive is demanding and always evolving. It requires
mastering a broad knowledge base and a deep skill set unique to the group practice
environment.
How do you objectively define the roles
and responsibilities of a medical practice
management executive? What qualities and
competencies must the successful executive
possess? How do you assess an individuals
performance? How will you assess your own
capabilities?

group practices across the country, big and


small, that use it to develop job descriptions
and professional development plans. Ask the
university and college health administration
programs that use it to develop their curricula.
Ask the countless professionals who have already
used it to advance their careers.

Just ask the medical practice executives who


used the Body of Knowledge for Medical Practice
Management to become Certified Members
and Fellows of the American College of Medical
Practice Executives (ACMPE). Ask the medical

The Body of Knowledge is the most


comprehensive, authoritative resource for those
who seek to assess and develop their skills and
knowledge in this profession.

What is the Body of Knowledge?

What is the origin of the Body


of Knowledge?

The Body of Knowledge for Medical Practice


Management encompasses a broad spectrum of
information about the profession. It defines the
unique knowledge and skill set for the medical
practice management executive.
The role of a medical practice management
professional is decidedly dynamic. Changes in
the healthcare industry, healthcare legislation,
technological leaps in information management
and many other factors contribute to the constant
evolution of the profession. Every book thats
written, every article published, every change
in legislation they all add to the Body of
Knowledge.
Quite simply, the Body of Knowledge is the
authoritative guide to managing a successful
medical group practice.

The Body of Knowledge for Medical Practice


Management was developed by the American
College of Medical Practice Executives (ACMPE),
the standard-setting and certification body of the
Medical Group Management Association (MGMA)
utilizing a role delineation study and an expert
panel of medical practice executives to define and
legitimize the unique knowledge and skill set for
the medical practice management profession.
The Body of Knowledge determines the content
and structure for a valid and reliable certification
program as well as developing educational
resources. The Certified Medical Practice
Executive (CMPE) and Fellow in ACMPE (FACMPE)
designations are the accepted marks of excellence
in the profession.

THE BODY OF KNOWLEDGE:


> Engage in continuing education: Many

universities and colleges use the Body of


Knowledge to develop curricula. The ACMPE
uses the Body of Knowledge for its certification
program. MGMA uses it to develop education
and information resources. Stay up-to-date with
the most current continuing education in the
profession.

> Developed by the American College of Medical

Practice Executives (ACMPE) in conjunction with


an expert panel of medical practice executives
> Defines and documents the professional
competencies and areas of responsibility, or
domains, required for successful medical group
management
> Outlines the knowledge and skills necessary
to attain board certification in medical practice
management through ACMPE

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mgma.com/acmpe

How will you use the Body of Knowledge?


Think of the Body of Knowledge for Medical Practice Management as a blueprint outlining
the knowledge and skills to guide your professional development and make your medical
practice successful.
ASSESS

EXCEL

> Evaluate your skills and knowledge: Use the

> Advance your career: Use the Body of

Body of Knowledge to identify your capabilities


in practice management.
LEARN
> Engage in continuous education: Take

advantage of MGMAs education programs


for every level of experience, from novice
to executive. Conferences, seminars, books
and online courses focus on expanding your
knowledge and skills. Visit mgma.com/acmpe
for a comprehensive list of resources.
CERTIFY
> Become certified: Obtain certification through

Knowledge as the foundation for your job


description, compensation structure and
employment contract.
> Improve your practice: Benchmark key areas

of your practice operations using the Body of


Knowledge as the foundation of an operational
assessment.
> Manage your staff and educate your physician

leaders: Benchmark staff performance reviews,


establish professional development plans and
inform your physician leaders about the key
success factors in practice management.

ACMPE, which is considered a mark of


excellence and proof of professionalism in the
medical practice management field. ACMPE
board certified professionals and Fellows
demand higher salaries than noncertified
professionals.

The Structure of the Body of Knowledge


The Body of Knowledge has been outlined to identify the various knowledge and skills
required of todays medical practice executive. Competencies are woven among eight distinct
knowledge areas or domains. Within each domain are tasks or statements detailing the
responsibilities that comprise that knowledge area. Tasks are further delineated as specific
skill statements. Visit mgma.com/bok to view the most up-to-date tools, resources and
educational opportunities.
Competencies

Tasks

Competencies are essential themes threaded


throughout the Body of Knowledge and form the
strong foundation for successful job performance.
Pages 4-5 describe the four competencies, or
skill sets crucial to performing each domain
successfully.

Tasks are individual job responsibilities, activities


and functions. Each domain in the Body of
Knowledge is defined by a series of tasks. Each
task is further broken down into an outline
of essential knowledge and skills required to
accomplish the specific task.

Domains
A body of knowledge is organized into major
areas of responsibility, called domains. Pages
6-21 present the eight domains in the Body of
Knowledge for Medical Practice Management.

mgma.com/acmpe

Body of Knowledge for Medical Practice Management | 3

COMMUNICATION SKILLS
PROFESSIONALISM

CRITICAL THINKING SKILLS


LEADERSHIP

The distinguishing marks of professional


development: Four competencies
What qualities and competencies must the successful executive possess? There are four
competencies that are critical across every role and responsibility a medical practice
management professional performs: professionalism, leadership, communication skills and
critical thinking skills. They form the strong foundation for every aspect of successful job
performance. For more information and up-to-date resources visit mgma.com/bok.

Professionalism
A commitment to achieving professional
standards that enhance personal and
organizational integrity and contribute to the
profession.

> Participate in and encourage service

> Commit to competence, integrity, altruism and

> Demonstrate and promote cultural sensitivity

promotion of the public good


> Commit to self-assessment and continuous

learning

and volunteer activities to support the


development of colleagues, staff and the
community

> Demonstrate knowledge of the healthcare

system and the environment in which it


operates

> Support collegial relationships with peers

through networking, information-sharing and


mentoring

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Leadership
Collaborating with and supporting the practices
physician leadership to provide strategic direction
to the organization.
> Uphold and advocate ethical standards and

decision-making
> Foster teamwork between clinical and

administrative staff
> Understand effective techniques for working

with boards and governance structures

> Focus on implementation of organizational

strategy
> Inspire others toward a shared vision
> Support innovation and creativity
> Demonstrate effective change management

skills to ensure effective patient care and


safety as well as improve practice performance
> Understand and effectively manage

expectations

Communication skills
The skills necessary to elicit multiple points
of view from internal and external sources,
facilitate constructive interaction and present
information clearly and concisely.
> Write clearly and effectively
> Speak clearly and effectively before

individuals and groups in formal and informal


settings
> Develop effective interpersonal skills
> Seek out and incorporate the views of

stakeholders for decisions that affect the


quality of care, work environment and
business stability of the organization

> Listen and respond effectively to the ideas and

thoughts of others
> Recognize and use nonverbal forms of

communication
> Demonstrate effective negotiation and

facilitation skills
> Support and promote effective conflict

resolution
> Provide effective communication linkages

within the organization and to its external


environment

Critical thinking skills


A systematic, logical approach to problem-solving,
decision-making and the development and
administration of systems to address day-to-day
issues and the long-term improvement needs of
the practice.
> Collect and analyze data from internal and

external sources relevant to each situation


> Demonstrate the ability to discriminate

between important and superfluous aspects of


situations to support sound decision-making

> Understand cause-and-effect relationships


> Learn from mistakes
> Manage the overload of information and stress

generated from diverse situations that occur in


the practice and in your personal life
> Implement planning methods and tools,

including project management, process


improvement and systems thinking

> Ask the right questions when making

decisions

mgma.com/acmpe

Body of Knowledge for Medical Practice Management | 5

How do you develop and implement an effective business plan? How do you
ensure the effective management of day-to-day operations? Business operations in a medical
practice include planning, purchase of materials and equipment, facilities management and
maintenance, business partnerships, and marketing and communication plans.

Business Operations
1 Develop, implement and monitor
business operation plans.
> A
 lign business plan with mission and
strategic plan of the organization
> I dentify types of business plans and plan
components
> Identify organizational goals and needs
> P
 lan for the future, set goals and assign
responsibility and accountability
> R
 eview and monitor effectiveness of business
plan and operations
> Understand project management techniques
> F
 ind opportunities to increase revenue
streams (e.g., new ancillary services, products),
including needs assessment, feasibility and
return on investment

3 Manage facilities planning and


maintenance activities to meet the
organizations current and future needs.
> E
 nsure effective facility planning, design and
layout to ensure efficient work flow, storage,
patient flow and patient safety
> O
 versee facility management and
preventative maintenance, including leasing,
landscaping, housekeeping, fire drills and
evacuation
> A
 pply utility requirements and maintenance
inspection schedules for mechanical, electrical
and plumbing
> E
 nsure regulatory compliance, including
Occupational Safety and Health
Administration (OSHA) and Americans
with Disabilities Act (ADA)

2 Develop, implement and oversee systems


for the purchase of materials and
equipment.
> I dentify types of supplies and equipment,
including fixed assets, nonbillable supplies
and billable supplies
> E
 stablish procedures for ordering, use and
monitoring of supplies and equipment
> E
 stablish purchasing procurement procedures,
including authorization, approval and
reconciliation
> I mplement an inventory control plan for
supplies and equipment
> E
 nsure proper disposal of biohazardous waste
products

Todays changing market


demands education, business
savvy and human relation skills
that only a manager who has
achieved credentialing in ACMPE
can offer.
Katherine Mack, business/case manager,
Coastal Physical Medicine and Rehabilitation
Services, New Bern, N.C.

> U
 nderstand equipment purchase vs. lease
options
> Ensure effective vendor relationships
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4 Manage discernment process for


identification and utilization of
outsourced expertise and business
partners.
> D
 etermine the need for outsourced expertise
for the organization
> E
 stablish selection requirements and process
for business partners
> P
 ursue and establish partnerships and
strategic alliances to strengthen competitive
position
> U
 nderstand the typical knowledge and
skills that financial advisors, accountants,
attorneys, architects and others can provide to
the practice
> E
 ffectively manage and monitor partnerships
and alliances

5 Develop and implement a marketing and


communications plan.
> F
 ocus on customers, including patients, other
physicians and groups, payers, vendors and
the community
> A
 pply the components of marketing and
communications plans, including situational
analysis, market analysis and consumer
analysis
> A
 nalyze local market trends, demographics
and current economic influences
> E
 mploy marketing research, market strategy
and advertising
> Use public and media relations
> E
 stablish corporate image and branding
strategy
> P
 romote community outreach and
collaboration

Refer to the Patient Care Systems


domain for tasks that relate to the
operational processes surrounding
the patient encounter.

RECOMMENDED RESOURCES:
For current Business Operations articles, tools, resources and education programs
visit mgma.com/BOKBusinessOperations.

mgma.com/acmpe

Body of Knowledge for Medical Practice Management | 7

How do you develop and maintain financial systems to ensure a profitable


practice? Financial management in a medical group requires skills in accounting,
budgeting, revenue cycle management and financial analysis.

DOMAIN:

Financial Management
1 Develop and implement the
organizations budget to achieve
organizational objectives.
> U
 nderstand types of accounting, including
financial, tax and managerial

2 Establish internal controls for cash


management.
> A
 ssess risk and identify where potential loss
can occur
> Implement bank reconciliation procedures

> A
 pply financial accounting principles,
including generally accepted accounting
principles (GAAP)

> E
 stablish a process to monitor and evaluate
internal financial control processes

> U
 nderstand cash and accrual accounting and
modified accrual accounting

> M
 onitor actual revenue and expenses to
budget and prior period amounts on a regular
basis

> U
 nderstand budgeting, types of budgets and
budget methodologies
> O
 versee accounts payable and accounts
receivable
> Implement a chart of accounts
> Understand methods of depreciation
> Track the flow of financial information
> Understand accounting systems and software
> Understand capital financing

> D
 evelop standard procedures and separation
of responsibilities for accounting functions
> R
 econcile the billing system with the
accounting system
> D
 evelop and implement policies for approvals,
authorizations, verifications, check signing
and invoices

3 Implement and maintain a process for


external financial audits.
> D
 etermine need for an external audit, review
or financial compilation for the practices
financial statements
> Understand types of audits and audit reports
> C
 omply with generally accepted auditing
standards (GAAS)
> E
 stablish effective relationships with
accountants and auditors

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4 Develop and implement revenue cycle


management and accounts receivable
management.
> M
 anage front-end operations, including
scheduling, insurance verification,
authorizations, co-pay collection, medical
record process, etc.
> O
 versee medical record documentation,
encounter form and coding
> Manage charge audit, charge entry and fees
> Ensure proper claims submission and edits
> I mplement accounts receivable follow-up,
including paid claims, unpaid claims, denied
claims, insurance collections and patient
collections
> M
 onitor net charges and cash collections
trends, days in accounts receivable, percent of
accounts receivable more than 90 days

5 Analyze and monitor financial


performance and report financial results
to stakeholders.
> U
 nderstand elements of financial statements,
including balance sheet, assets, liabilities,
equity, investments, distributions, revenues,
expenses, gains, losses and income
> C
 onduct financial analysis, including
measures of profitability, profitability ratios,
current/prior period comparison, comparisons
by department/location/division and
productivity analysis
> C
 onduct financial benchmarking, including
revenue, expenses, adjusted collection
rate, collection rate by payer, payer mix,
reimbursement, productivity, accounts
receivable and profitability
> C
 ommunicate financial information to
stakeholders such as graphs, narratives,
presentations, dashboards, scorecards and
executive summaries

6 Direct the payroll process.


> E
 stablish policies and procedures to ensure the
organization is paying employees the correct
amount for the exact hours worked
> I mplement reporting system to gather
employee work hours
> E
 nsure accurate record-keeping for payroll
records
> E
 nsure regulatory compliance for payroll
filing, including Federal Insurance
Contributions Act (FICA), social security,
deferred compensation and workers
compensation
> E
 stablish guidelines and process for
monitoring payroll recorded benefits
> C
 omplete all payroll audits as required by tax
agencies, insurers or government entities

7 Establish and maintain the


organizations banking, investment and
other financial relationships.
> D
 evelop effective working relationships with
bankers, accountants, auditors, consultants,
real estate professionals, life insurance
professionals, attorneys and other outside
financial professionals
> E
 stablish periodic regular review with
physicians regarding financial relationships

8 Develop relationships with individual


insurance carriers to optimize contract
negotiations and maintenance of
existing contracts.
> E
 stablish formal review of insurance carrier
contracts as well as auditing contract
payments
> A
 nalyze payer performance, including timely
payment, correctness of payment and denials
> Manage contracts
> Develop negotiation skills
> E
 stablish personal contacts within each major
carrier

RECOMMENDED RESOURCES:
For current Financial Management articles, tools, resources and education programs
visit mgma.com/BOKFinancialManagement.

mgma.com/acmpe

Body of Knowledge for Medical Practice Management | 9

How do you utilize human resources to achieve and enhance organizational


performance? Human Resource Management involves staff recruitment and retention,
an effective staffing strategy, training, a performance evaluation process, a personal
commitment to enhancing your knowledge base and compliance with employment laws.

Human Resource Management


1 Coordinate the recruitment and
orientation process of clinical and
nonclinical staff.
> I dentify recruitment sources and techniques,
including internal posting, advertising, search
firms and temporary agencies
> R
 ecruit clinical and nonclinical staff to
meet the skill mix and staff needs of the
organization and its culture
> R
 ecruit with an emphasis on customer- and
patient-focused skills
> Define job scope and develop job descriptions
> D
 evelop interviewing skills, ensuring
regulatory compliance
> E
 stablish effective selection process, including
pre-employment screening, background,
criminal and reference checks

2 Manage the retention of clinical and


nonclinical staff.
> M
 anage employee motivation and teamwork
to obtain high performance
> E
 nsure a healthy workplace environment,
including conflict resolution process and
grievance procedure

3 Develop and monitor an effective staffing


strategy.
> I dentify and analyze staffing needs and
expectations
> I dentify the various roles staff and physicians
play in a group practice
> E
 stablish job classification systems, including
position analysis, job descriptions and
working conditions
> E
 nsure the appropriate number of clinical and
nonclinical staff with the correct mix of skills
> A
 nalyze the impact of work space on staffing
levels
> Use and benchmark data for effective staffing

4 Develop, implement and evaluate


performance management programs for
clinical and nonclinical staff.
> I mplement performance management review
system, including performance standards,
professional development plans, goal-setting,
schedule for periodic reviews and evaluation
tools
> E
 stablish policies and procedures for job
promotions

> A
 nalyze employee turnover and develop a
strategy for improvement

> E
 nsure an effective process to manage
performance and behavior

> I mplement an employee satisfaction survey to


measure employee engagement and to create
opportunities to enhance the workplace

> M
 aintain documentation and personnel
records

> P
 rovide access to an employee assistance
program

> I mplement policies and procedures for


terminating employees

> E
 nsure accurate record-keeping for personnel
records
> Understand labor relations
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5 Develop and implement staff


compensation and benefit plans

7 Establish systems and processes for

> U
 se market data to develop and monitor a
wage and salary strategy

awareness, education and compliance


with employment laws and regulatory
standards.

> E
 nsure effective compensation and benefit
administration

> M
 aintain an updated employee handbook of
human resource policies and procedures

> E
 valuate types of benefit plans, including
defined benefits, defined contribution, 401(k),
403(b), self-directed, employer-directed and
profit sharing plans

> Ensure staff education and training

Department of Labor

> E
 valuate insurance, retirement and severance
benefits

Fair Labor Standards Act (FLSA)

A mericans with Disabilities Act (ADA)

> Ensure confidentiality of compensation data

Family and Medical Leave Act (FMLA)

> O
 versee compensation for clinical staff
refer to the Organizational Governance
domain, Task 5

E
 qual Employment Opportunity
Commission (EEOC)

Equal Pay Act

6 Provide systems, processes and structure

Civil Rights Act/Title VII

Age Discrimination in Employment Act

Affirmative Action

> F
 oster a culture of learning and professional
development

E
 mployee Retirement Income Security Act
(ERISA)

Workers compensation

> O
 versee training, including orientation,
management, technical skills, career
development, certification and cross-training

H
 ealth Insurance Portability and
Accountability Act (HIPAA)

C
 onsolidated Omnibus Budget
Reconciliation Act (COBRA)

O
 ccupational Safety and Health
Administration (OSHA)

National Labor Relations Act (NLRA)

for administrative and clinical training


for medical providers, employees and
students.

> I mplement effective training programs


that include on-the-job training processes,
continuing education and professional
development activities
> U
 nderstand adult learning styles and delivery
methods, including computer-based training,
distance learning and classroom teaching
> E
 stablish policies and procedures for
training, including time off for training,
paid attendance, and continuing education
requirements of professional and licensed
staff

> E
 nsure compliance with employment laws,
including but not limited to:

8 Provide personal commitment to


enhance knowledge, skills and abilities
in healthcare administration.
> D
 evelop management and leadership skills to
enhance performance and effectiveness
> E
 ngage in continuous learning to acquire
advanced professional knowledge
> D
 emonstrate and foster ethical standards,
behavior and decision-making
> D
 evelop interpersonal skills and selfawareness

RECOMMENDED RESOURCES:
For current Human Resource Management articles,
tools, resources and education programs visit
mgma.com/BOKHumanResourceManagement.

> D
 evelop effective communication skills
including written communication and
presentation skills
> D
 evelop effective stress management and
time management skills
> Display self-confidence and personal integrity

mgma.com/acmpe

Body of Knowledge for Medical Practice Management | 11

We live in an electronic world and you oversee countless pieces of information. How
will you manage evolving technologies, practice management systems, electronic health
records and compliance? In a medical practice, robust information systems and strong
information management capabilities are essential strategic resources.

Information Management
1 Develop and maintain appropriate
internal communication pathways for
clinical and nonclinical staff.
> E
 stablish communication system for patients
to reach physicians and support staff
> E
 stablish communication system for clinical
and nonclinical staff to communicate among
themselves and with other healthcare
providers and organizations, and to respond to
patient requests
> E
 nsure good communication pathways
through careful planning, selection of
appropriate communication channel and a
consistent professional message
> O
 versee meeting management, including
facilitation skills, agendas, decision-making
processes and record-keeping
> F
 oster ongoing development of effective
interpersonal communication skills
> U
 nderstand the interplay and options for
internal and external communication systems
and channels, including telecommunications,
answering service, voice mail, fax, Internet,
Web sites, e-mail, cellphones, pagers and mail
services

2 Develop a technology plan that


establishes the criteria for selection
and implementation of information
technology, including computer
systems, Internet strategies and
telecommunications.
> D
 evelop an effective technology plan
and budget to support business needs
and organizational goals, including an
information system needs assessment
> U
 nderstand types of information technology
systems and applications used in a medical
practice, including practice management
systems, accounting and billing systems,
electronic communication, EHRs, prescription
management and disease management
> E
 nsure appropriate information technology
selection, procurement and installation,
including request for proposals, a selection
committee, physician buy-in, vendor
relationships, contract negotiation and
technical support
> E
 nsure effective technology implementation,
including installation, training, work flow
redesign, process integration, reporting and
ongoing support
> E
 nsure maintenance of technology systems,
equipment and services, including personal
computers, networking, telecommunications,
Web portals, application systems, software
and technical support
> E
 nsure training and support for clinical and
nonclinical staff

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3 Plan and design a technology security

5 Develop and implement processes

process to protect patient and practice


data systems.

to comply with mandated reports of


specified patient issues to regulatory
agencies.

> E
 nsure effective security processes and
standards for technology systems and
applications as well as current technological
threats

> U
 nderstand reporting requirements for
medical conditions as established by state and
federal department of health

> E
 nsure information integrity, security and
confidentiality according to the Health
Insurance Portability and Accountability
Act (HIPAA)

> G
 ain knowledge of disease, vaccine and other
registries that require physician reporting
> E
 nsure compliance with federal and state
requirements for biohazard or epidemic
response requirements

> O
 versee database management and
maintenance

> D
 evelop a technology disaster management
plan
> E
 stablish and implement security audit
procedures for all technology systems
> D
 evelop policies to address employees
personal use of the practices technology

The ACMPE certification


program is a good example

> D
 evelop policies to prevent the theft or loss of
technology equipment, including items which
contain employee or patient data

of how to ensure that our


professionals possess basic

4 Manage medical information systems

competencies in a variety

including medical records, medication


administration and healthcare related
document storage.
> D
 evelop and maintain policies for release,
update and maintenance of confidential
information, in accordance with Health
Insurance Portability and Accountability Act
(HIPAA)

of areas.

E
 laine Bertles, director of clinical services,
Watson Clinic LLP, Lakeland, Fla.

> E
 stablish policies for document and electronic
record storage, retrieval and destruction
> E
 stablish requirements and processes to
ensure all technological systems have
fault-tolerance in accordance with accepted
standards for continuous availability
> E
 stablish policies and procedures that adhere
to regulatory requirements for the prescribing,
transmission and monitoring of patient
medications
> E
 nsure security of protected health
information (PHI)

RECOMMENDED RESOURCES:
For current Information Management articles, tools, resources and education programs
visit mgma.com/BOKInformationManagement.

mgma.com/acmpe

Body of Knowledge for Medical Practice Management | 13

Effective governance is essential to a successful medical practice. How do you


ensure effective governance and leadership through policies, long-term strategies and the
strategic direction of the organization?

Organizational Governance
1 Facilitate the establishment and
monitoring of the appropriate corporate
legal structure for the organization.
> U
 nderstand types of legal structures,
including sole proprietorship, professional
corporation, limited liability partnership,
limited liability company and business
corporation
> R
 ecognize liability and taxation issues related
to the legal structure
> M
 aintain legal compliance with corporate
structure, including tax law, physician selfreferral (Stark law), anti-kickback law, False
Claims Act and antitrust laws
> U
 nderstand the impact of the legal structure
on the governance system and culture of the
organization

> U
 nderstand board composition and procedural
rules
> M
 aintain adherence to corporate bylaws and
review annually
> P
 rovide orientation and ongoing training for
board and committee members
> Ensure record-keeping and record retention
> Maintain organizational history
> P
 articipate in board/committee meeting
management and board evaluation
> Ensure effective succession planning

3 Lead the integration of the corporate


mission statement into all aspects of the
organizations culture.

> Use outsourced expertise of an attorney

> E
 ffectively communicate the organizations
mission, vision and values to influence the
strategic direction

> D
 evelop shareholder agreements and
physician employment contracts

> P
 rovide leadership, innovative thinking and
change management

> U
 nderstand the impact of independent
practice associations (IPAs), hospitals and
ancillary providers

> U
 nderstand organizational culture, including
patterns of behavior, shared values, traditions,
politics, power and group interaction

2 Facilitate organizational governance


structure and maintain proper corporate
record-keeping of strategic decisions.
> S
 upport the governing body in the
development of a committee structure to meet
the needs of the organization

> U
 phold and advocate ethical standards,
behavior and decision-making
> Foster a culture of trust and respect
> M
 anage the intricate interrelationships of the
organization, staff and stakeholders

> U
 nderstand types of committees within a
governance structure, including finance,
personnel, quality review, research, recruiting,
performance and ad hoc
> D
 ocument the roles and responsibilities of the
board of directors and committees
14 | Body of Knowledge for Medical Practice Management

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4 Lead development of the organizations


strategic plan and its implementation.
> U
 nderstand components of a strategic plan,
including mission, vision, values, goals and
objectives
> C
 onduct SWOT (strengths, weaknesses,
opportunities and threats) analysis
> F
 acilitate group self-assessment and
stakeholder needs assessment
> Understand market trends
> Facilitate board monitoring and review
> F
 acilitate board retreat and meeting
management

5 Establish, communicate, implement and


monitor production and compensation
standards for physician and midlevel
professional staff.
> E
 nsure linkage between the compensation
plan and the organizations mission, goals and
culture
> I mplement an effective allocation system
of revenues and expenses, serving as a
performance, incentive and feedback system
for physicians
> U
 nderstand components of an effective
compensation system, including practice
and physician goals, rewarding productivity
and clarifying physician responsibility and
accountability
> R
 ecognize compensation plan considerations,
including practice size, practice setting,
capitation and on-call obligations

6 Implement and/or support organization


leadership management of clinical staff
conduct and performance expectations or
programs.
> D
 ocument professional standards of conduct
and expectations
> E
 stablish professional standards violation
policy for physicians
> E
 ffectively communicate and clarify
performance expectations
> S
 upport organization leadership, the
governing body or a professional standards
committee, regarding conflicts of interest,
performance issues and disruptive behavior

7 Foster the growth and development of


physician leaders as knowledgeable,
participative stakeholders.
> W
 ork effectively with the leadership to foster
a team culture
> E
 nsure effective communication between
physicians and administrative staff
> F
 oster the development and growth of a
physician/administrator leadership team
> C
 ommunicate, educate and facilitate
physician understanding of good business
standards and financial practices
> Facilitate conflict resolution
> Demonstrate professional integrity

8 Encourage and lead participation in


advocacy endeavors at local, state and
national levels.

> U
 nderstand types of compensation plans,
including individualistic models, teamoriented models and base salary plus incentive

> U
 nderstand how social, political and legal
issues affect access, cost and quality of
healthcare

> U
 nderstand revenue allocation methods,
including actual collections, gross or net
charges, work RVUs and hybrid measures

> P
 articipate in local, state and national
advocacy efforts affecting healthcare
management

> U
 nderstand expense allocation methods,
including cost accounting and modified cost
accounting

> Educate staff on advocacy issues

> U
 nderstand practice buy-in, buy-out and
transition arrangements
> E
 nsure regulatory compliance, including Stark
and anti-kickback laws

mgma.com/acmpe

> E
 ncourage and participate in community and
civic activities

RECOMMENDED RESOURCES:
For current Organizational Governance articles,
tools, resources and education programs visit
mgma.com/BOKOrganizationalGovernance.

Body of Knowledge for Medical Practice Management | 15

A critical component of medical practice management is the effective and efficient processes surrounding the patient encounter. How do you ensure that patients receive
the best possible care, focus on patient safety and strive for efficient operations?

Patient Care Systems


1 Establish and monitor business processes
to ensure effective and efficient clinical
operations.
> E
 nsure effective operations to ensure clinical
quality-of-care standards
> Understand and monitor patient outcomes
> G
 ain knowledge of emerging models for
healthcare delivery
> Ensure effective nurse triage systems
> U
 nderstand principles of clinical trials
research

2 Provide relevant and accurate resources


to enhance patients knowledge,
understanding and participation in their
medical care.
> E
 stablish patient communication procedures,
including appointment confirmations, followup, notifications and financial counseling

3 Develop and implement a referral


management process.
> U
 nderstand the referral process and plan
requirements
> Enhance referrals in and out of the practice
> E
 stablish administrative protocols for followup and reporting
> D
 evelop and foster good relationships with
referral physicians

4 Design efficient patient flow patterns to


maximize physician schedules.
> E
 stablish an effective patient flow process,
including registration, appointment
scheduling, patient arrival and check-in,
encounter management, and patient checkout
> M
 anage practices daily flow, including
emergencies, cancellations and no-shows

> F
 acilitate patient educational support and
materials

> U
 nderstand scheduling methodologies and
systems for physician maximization

> E
 stablish procedures for informed consent and
disclosure of unanticipated outcomes

> E
 nsure effective scheduling of clinical and
nonclinical staff

> E
 nsure documentation and communication of
the patients treatment plan

> Establish emergency call procedures

> Oversee prescription and refill management


> E
 stablish policies and procedures for
termination of care and the patient
relationship

mgma.com/acmpe
16 | Body of Knowledge for Medical Practice Management

5 Manage front office operations to


maximize patient satisfaction, collection
of payments and customer service efforts.
> Establish call center processes and procedures

For manager or executive

> Establish pre-visit registration process

openings, we always pay

> Ensure effective patient check-in

particular attention to

> Oversee billing and collections


> Promote patient-focused customer service
> E
 nsure confidentiality and compliance
with the Health Insurance Portability and
Accountability Act (HIPAA)

6 Implement a plan to control

candidates who are board


certified or Fellows in ACMPE.
Certification indicates broad and
thorough knowledge of practice

pharmaceutical supplies.

management and that can make

> U
 nderstand types of pharmaceuticals,
including vaccines, injectable medications,
narcotics and samples of prescription
medications

a real difference to our business.

> E
 stablish procedures for security, storage and
access of pharmaceutical supplies

Frank Ford III, FACMPE, vice president,


physician services, Mission Hospital,
Asheville, N.C.

> E
 stablish an inventory system, including
rotation of stock, tracking of utilization and
disposal
> E
 nsure regulatory compliance of
pharmaceutical supplies
> E
 ffectively manage relationships with
pharmaceutical sales representatives

RECOMMENDED RESOURCES:
For current Patient Care Systems articles, tools, resources and education programs
visit mgma.com/BOKPatientCareSystems.

mgma.com/acmpe

Body of Knowledge for Medical Practice Management | 17

For your practice to thrive, quality management programs must be developed for both
patients and staff. How will you best implement those programs? How will you ensure the
effective development and implementation of continuous process improvement?

Quality Management
1 Design and implement a quality

3 Develop and oversee patient satisfaction

management system that leads to the


improvement of healthcare delivery and
ensures patient safety.

and customer service programs.

> E
 ngage clinical and nonclinical staff to apply
quality management approaches to address
and ensure safety for patients and staff as well
as improve business and clinical operations

> D
 esign and implement patient satisfaction
survey, analyze results and implement
improvements to operations and customer
service

> U
 nderstand quality management approaches
and philosophies, including Total Quality
Management, Six Sigma and Lean Thinking

> Implement customer service training for staff

> A
 pply quality management tools such as
process maps, run charts, Pareto diagrams,
flowcharts, affinity diagrams and decision
matrices
> U
 nderstand the cost of quality, including
internal failure costs, external failure costs,
appraisal costs and prevention costs
> E
 stablish continuous process improvement
review and practice assessment, including
coding documentation, risk assessments, chart
audits and auditing regulatory compliance

2 Monitor the peer review process for


clinical staff.

> U
 nderstand and select an appropriate survey
instrument to measure patient satisfaction

> Foster a customer service focus and culture

4 Identify, develop and maintain


benchmarks for establishing practice
performance standards.
> I mplement a data collection strategy and plan,
identifying meaningful measurements to
benchmark
> D
 evelop effective benchmarking reports, such
as dashboards and scorecards
> I dentify key metrics for financial growth,
customer service, quality and innovation
> I dentify appropriate internal and external
benchmark data to guide strategy
performance

> U
 nderstand malpractice insurance carriers
requirements for reporting, researching and
defending claims
> E
 stablish and oversee protocols and processes
for managing adverse events
> S
 upport physician leadership in the design
and implementation of an effective peer
review process

18 | Body of Knowledge for Medical Practice Management

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5 Create internal processes and systems

6 Develop and monitor a program for staff,

to participate in pay-for-performance
programs to enhance healthcare quality.

business and equipment credentialing


and licensure.

> D
 evelop a process for capturing clinical data
needed for reporting

> I mplement a process for physician enrollment


in health plans for hospital privileges and to
maintain medical licenses

> M
 easure effectiveness and value of
participating in pay-for-performance
programs
> E
 ngage physicians in establishing clinical
pathways and clinical protocols
> E
 ngage physicians in participating in pay-forperformance programs
> U
 nderstand third-party quality measurement
requirements such as the Health Plan
Employer Data and Information Set (HEDIS),
the National Committee for Quality Assurance
(NCQA) and the Physician Quality Reporting
Initiative (PQRI)

> E
 nsure regulatory compliance with licensing
and credentialing requirements
> E
 nsure the organization meets accreditation
requirements for organizations and
facilities, including the Joint Commission on
Accreditation of Healthcare Organizations
(JCAHO) and the Accreditation Association for
Ambulatory Health Care (AAAHC)
> E
 nsure compliance with requirements for
clinical laboratory services, i.e., Clinical
Laboratory Improvement Act (CLIA)

Obtaining the CMPE


designation is essential for
practice managers to elevate
their credibility and our
profession.
Valerie L. Johnson, CMPE, business
officer/administrator, Health Center
Montgomery, University of AlabamaBirmingham, Montgomery, Ala.

RECOMMENDED RESOURCES:
For current Quality Management articles, tools, resources and education programs
visit mgma.com/BOKQualityManagement.

mgma.com/acmpe

Body of Knowledge for Medical Practice Management | 19

Risk management is essential to protect the assets of the organization. How do you
ensure compliance with all regulatory bodies and protect the practice from medical
malpractice and adverse legal events?

Risk Management
1 Develop and implement a risk
management plan to ensure a safe
environment for patients, staff and
visitors.
> U
 nderstand risk management process
components, including risk identification, risk
analysis, loss control alternatives to manage
potential risks, and monitoring risk control
techniques
> D
 evelop a risk management plan including
policies on blood-borne pathogens, emergency
response, respiratory safety, fire safety,
personal protective equipment, material
safety data sheets and right-to-know for
hazard communication materials
> P
 eriodically monitor new issues relating
to risk management as they arise and
incorporate into the risk management plan
> C
 onduct regular and ongoing risk exposure
monitoring
> E
 nsure compliance with legal requirements of
record-keeping, including retention, storage,
retrieval and destruction
> E
 nsure staff are properly trained in all aspects
of risk and safety, including infection control,
environmental hazards and medication errors

2 Develop and implement policies and


procedures to manage the impact of
adverse legal events.
> A
 ssess and procure insurance coverage,
including professional liability, medical
malpractice liability, general liability,
property and casualty, and directors and
officers liability
> U
 nderstand and identify possible adverse
legal events
> U
 nderstand personal impact of legal events on
physicians and the organization
> I nvestigate all grievances, claims and
complaints against the organization, assessing
legal ramifications
> U
 se and develop effective relationships with
insurance brokers and legal counsel

3 Establish a plan for disaster response and


recovery.
> C
 oordinate disaster preparedness, including
planning, implementation and recovery
> E
 stablish emergency and evacuation
procedures
> U
 nderstand and identify the organizations
vulnerabilities to various type of disasters and
catastrophic events
> D
 evelop an effective disaster recovery plan to
ensure business continuation

20 | Body of Knowledge for Medical Practice Management

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4 Develop and implement a compliance


program for federal and state laws and
regulations.
> U
 nderstand the components of a compliance
program, including standards of conduct,
designation of a compliance officer, effective
training, effective lines of communication,
auditing and monitoring, disciplinary
guidelines and corrective action initiatives
> Conduct periodic compliance audits
> E
 nsure regulatory compliance, including but
not limited to:

D
 epartment of Health and Human Services
(HHS), Office of Inspector General (OIG)

P
 hysician Self Referral Stark law, antikickback law and antitrust

C
 enters for Medicare & Medicaid Services
(CMS)

H
 ealth Insurance Portability and
Accountability Act (HIPAA)

O
 ccupational Safety and Health
Administration (OSHA)

Clinical Laboratory Improvement Act (CLIA)

C
 enters for Disease Control and Prevention
(CDC)

E
 mployment laws and regulations refer
to the Human Resource Management
domain, Task 7

Early in my career, I was


learning on the fly until I heard
about MGMA and ACMPE from a
colleague. The board certification
process gave me a much clearer
picture of how all areas of practice
management are connected and
the tools I need to really move my
practice forward.
R
 uth Lander, FACMPE, practice
administrator, Columbus Oncology
Associates Inc., Columbus, Ohio

RECOMMENDED RESOURCES:
For current Risk Management articles, tools, resources and education programs
visit mgma.com/BOKRiskManagement.

mgma.com/acmpe

Body of Knowledge for Medical Practice Management | 21

APPENDIX

Your pathway to ACMPE board certification and Fellowship


One of the best career decisions you can make as a medical practice management professional
is to earn board certification and Fellowship through the American College of Medical
Practice Executives (ACMPE).
The Certified Medical Practice Executive (CMPE) and Fellow in the ACMPE (FACMPE)
designations command the highest levels of respect and recognition in your field.

Becoming a Certified Medical Practice


Executive (CMPE)

Becoming a Fellow in the ACMPE


(FACMPE)

ACMPE uses the Body of Knowledge for Medical


Practice Management as the foundation for
assessments, examinations and other resources
for the board certification program. The board
certification process requires you to:

The FACMPE designation is the highest


distinction in medical practice management. It
demonstrates that you have made significant
contributions to your career and your profession.
To advance to Fellow status, individuals will
need to:

> Enter the certification program


> Meet eligibility requirements
> Pass a 175-item, multiple-choice objective

exam that measures your understanding of


medical practice management principles and
practices
> Pass a written essay exam that gauges your

in-depth knowledge of medical practice


management, problem-solving and decisionmaking skills as well as your ability to
communicate effectively in writing

> Complete the requirements to earn the

Certified Medical Practice Executive (CMPE)


designation
> Enter the Fellowship program
> Write a professional paper or case studies
> Earn and maintain continuing education hours

Visit mgma.com/fellowship for more


information.

> Earn and maintain a minimum of 50

continuing education hours


Visit mgma.com/certification for more
information.

> Take the Personal Inventory self-evaluation:

Assess your current skills and knowledge in the


profession at mgma.com/inventory.
Get more information and resources online:
Visit mgma.com/bok to view the most up-todate resources, tools, recommended books,
seminars and educational opportunities to
support your professional development and
practice improvement.

22 | Body of Knowledge for Medical Practice Management

mgma.com/acmpe

11%

9%

6%
19%
12%
Preparing for the certification exams
The Body of Knowledge is the outline for the ACMPE objective and essay examinations. It is designed
16% the specific content
16% that may be tested. The objective
to help you prepare for the exams by identifying
exam is designed with the percentage emphasis presented on this page for each of the eight knowledge
11% are essential to performing each knowledge
domains. Additionally, the four professional competencies
domain successfully: professionalism, leadership, communication skills and critical thinking skills.
Identifying and defining those competencies are part of the exams.

Risk Management
Quality Management

6%

9%

11%

11%

9%

6%
19%

Patient Care
Systems

12%

Business Operations

19%

Financial
Management

12%

11


Organizational
Governance

16%

16%

16% 16%
11%

11%

6%

H
 uman Resource
Management

Information
Management

12%

TIPS:
> Are you ready to realize your professional development goals and become certified? Take the

16%

first step and assess your knowledge and skills with the Personal Inventory a free, online tool at
mgma.com/inventory.
> Identify strengths and weaknesses with the in-depth, member-recommended Knowledge

Assessment. Find out more at mgma.com/assessment.


> Prepare for the certification exam by purchasing the Certification Exam Workbook at

mgma.com/workbook.
> Find the most current information about certification and Fellowship at mgma.com/acmpe.

mgma.com/acmpe

Body of Knowledge for Medical Practice Management | 23

Thank you to the ACMPE-member volunteers for their expertise and dedication to the
Body of Knowledge update project. These individuals served as subject matter experts to
address the evolving roles and skills required for a medical practice executive.

CREDITS:
2007-2008 ACMPE Body of Knowledge Task Force:
> Becky L. Ayers, MHA, MBA, FACMPE

> R. Andrew Nelson, CMPE, MBA

> David A. Caldwell, MPH, MBA, CMPE, FACHE

> Jayne L. Testa, CMPE

> Rebecca S. Dean, MA, FACMPE

> Ed Whitver, MBA, CMPE, CAE

> Frank Ford III, MBA, MHS, FACMPE

> Debra J. Wiggs, FACMPE

> William S. Henderson, FACMPE


> Samantha Kempster, MBA, CMPE

Psychometric consultant:
> Stephen B. Johnson, PhD, CASTLE Worldwide

> Janet E. McIntyre, MBA, FACMPE


> James B. Mitchell, CMPE
> Charles D. Moses, MBA, MSHA, FACMPE,

Staff liaison:
> Laura Woodruff, MA, ACMPE director

CMQM/OE

Production Credits
Content Editors:
> Lindsay Hayes, MA
> Heather McHugh, MBA

24 | Body of Knowledge for Medical Practice Management

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The Body of Knowledge for Medical


Practice Management is the most valid
and reliable resource available in the
field. Developed by ACMPE, it is based
on an extensive study of group practice
management professionals that identified
the current knowledge and skills necessary
for competent performance.

The American College of Medical Practice


Executives (ACMPE) is the standard-setting
and certification body of the Medical
Group Management Association (MGMA).

BODY OF KNOWLEDGE FOR

Medical Practice
Management

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Toll-free 877.275.6462, ext. 1869


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